Residential Aged Care Services in Tasmania

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Residential Aged Care Services in Tasmania

• On the edge of extinction

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Before the Reforms of 1997

• A cottage industry managed by people of goodwill,
  grateful to the government of the day for their
  largesse
• Clients who were expected to be grateful for
  their care
• Regular direct involvement by local bureaucrats
• Standards Monitoring teams reviewed care and
  claims for funds

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Aged Care Act 1997

• Competition
• Certification
• Accountability of Providers
• Charter of Rights
• Accreditation Agency
• Validation
• Complaints Resolution Scheme
• Business Model

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Early Days

• Successful in forcing change
• Accreditation spelt out standards
• Certification established minimum standards
  especially in relation to fire
• Stated expected building requirements to be
  achieved by 2008 in relation to privacy and
  dignity
• Large turnover of senior staff in organisations

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Progress

• Standards improved
• Standards often assessed in subjective manner
• Low care residents paying bonds
• Providers able to borrow and service debt
• Development of improved standards of
  accommodation
• Complaints Resolution Scheme- a costly impost

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Business Model Flaws Emerge

• Government-
• Controls supply of beds
• Sets standards of accommodation
• Defines services to be provided
• Regulates fees to be charged
• Controls access to capital
• Controls who is eligible for care

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Supporting Success or Ensuring Failure?

• Funding not keeping pace with costs. Services
  predicting significant losses
• Cap funding just before 30th June 2004
• Penalty for this funding -more compliance
• Kerosene baths claw back on funding

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Elder Abuse

• The most common form of elder abuse is financial
  abuse
• The most common abuser of the elderly is a family
  member
• Nursing Homes now required to have national
  Police Checks for all staff, volunteers and
  contractors who have direct access to residents.
• This does not include GPs
• This represents an unfunded burden of approx 50
  per person.
• Compulsory Reporting requirements needed new
  policies, procedures, recording and monitoring
  systems and training for all staff. I estimate
  that this cost 3000 set up plus 50 per employee
  per facility per annum

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Supporting Success or Ensuring Failure?

• Elder Abuse- Costly regime for homes
• Additional prudential requirements-
• no facility has defaulted on a bond since the
  introduction of Aged Care Act 1997

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Compliance or red tape frenzy?

• Annual workforce census for each site
• Annual Staff training statement for each site
• Annual Financial Statements
• Annual CAP Return

• Residential Aged Care Funding Claim
• Monthly per facility
• BAS ATO Quarterly
• Annual Prudential Compliance Statement

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How Much Regulation?

• Certification duplicates the BCA and
• State and Local Government requirements
• Accreditation 4 standards 44 Outcomes
• Police Checks
• Mandatory reporting
• Nursing Board

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Accreditation

• 4 Standards with 44 Outcomes
• Service must be compliant at all times
• Spot visits (Can be triggered by a complaint or a
  change of senior personnel)

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Burden of Proof -Paperwork

• To satisfy accreditation Standards we must-
• Achieve the outcome for each resident
• Provide evidence of how this is achieved
• How it is tested?
• How it is evaluated?
• How it is improved?

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Performance-Accreditation

• 2000- 63.5 fully compliant
• 2004- 87.9 fully compliant
• 2007- 91.8 fully compliant
• Exceptional performance in the industryindeed
  in any industry
• Australia is leading international performance
  CEO of Accreditation Agency, Sept 2007

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Performance 2003-present

• In this period out of over 2,800 facilities, 42
  have incurred sanctions or just 0.015
• NSW -8 facilities
• Victoria -12
• NT- 1
• Qld- 17
• WA- 4
• Tasmania- 0
• ACT -0

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Complaints

• Why dont we buy Twinings tea?
• Why havent you got this person a Doctor?
• My father did not receive anything to eat or
  drink for a week.
• My mother was. shouted at by a staff member

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How many instruments does it take to deal with a
complaint?

• Potential for a complaint to be running
  concurrently with-
• DOHA
• Health Complaints Commission/ Medical Council
• Nursing Board of Tasmania
• Guardianship Board
• Unions

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Signs of Industry Stress

• Growth of costs of compliance
• Small operators depart the scene
• Consolidation of providers

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Signs of Industry Breakdown

• Skill shortages especially RNs and sophisticated
  business skills
• Industry becomes government whipping boy
• Community expectations exceed capacity to deliver
• Providers starting to report losses on operations

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Situation decline

• Changed profile of residents entering residential
  aged care
• 69 of residents in 2005-2006 were high care
• No bonds for high care (Except for Extra Services
  places)
• Costs of care increasing beyond funding levels
• Costs of compliance growing as requirements
  increase

• Government continues to react to exceptional
  events and impose further requirements

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Desperation emerges

• Exit of some large providers from the industry
  e.g Salvation Army, some Anglican services
• Growth of property development in retirement
  living
• Blurs community perception of options for
  supported care and viability

• Residential Aged Care providers subsidising
  operations from unit developments

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Closures

• Small services close
• Government funding sidelines low care
• Specialist services under threat
• Dementia care too expensive to provide
• Emphasis placed on elderly remaining in their own
  home

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Residential Aged Care-
The end